Provider Demographics
NPI:1235258658
Name:CHARITON GROUP HOME DEVELOP CORP
Entity Type:Organization
Organization Name:CHARITON GROUP HOME DEVELOP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM OF GROUP HOME
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:BA AND BS IN SECONDA
Authorized Official - Phone:641-774-8252
Mailing Address - Street 1:PO BOX 462
Mailing Address - Street 2:
Mailing Address - City:CHARITON
Mailing Address - State:IA
Mailing Address - Zip Code:50049-1531
Mailing Address - Country:US
Mailing Address - Phone:641-774-8252
Mailing Address - Fax:
Practice Address - Street 1:1221 BROOKDALE AVE
Practice Address - Street 2:
Practice Address - City:CHARITON
Practice Address - State:IA
Practice Address - Zip Code:50049-1531
Practice Address - Country:US
Practice Address - Phone:641-774-8252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities